Immune reconstitution inflammatory syndrome-Unmasking endophthalmic, lymphadenopathic, and neuromeningeal cryptococcosis in an HIV-infected patient starting highly active antiretroviral therapy

A 37-YEAR-OLD HOMOSEXUAL was admitted for dysphagia and cachexia. A diagnosis of HIV infection was made 17 months before [CD4 super(+) 476/ mu l (21%) and HIV viral load 190,000 copies/ml]. He refused highly active antiretroviral therapy (HAART) and did not return for follow-up. Actually he had oral candidiasis and multiple lymphadenopathies. His CD4 super(+) cell count was 27/ mu l (2%) and he had an HIV viral load of 6 x 10 super(6) copies/ml. Hepatitis, syphilis, cytomegalovirus (CMV), Toxoplasma serologies, and a purified protein derivative (PPD) skin test were negative.